Provider Demographics
NPI:1174877005
Name:CARMACK, ROSIE M
Entity type:Individual
Prefix:MS
First Name:ROSIE
Middle Name:M
Last Name:CARMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 SCHULTE BLVD
Mailing Address - Street 2:#703
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5994
Mailing Address - Country:US
Mailing Address - Phone:979-203-2294
Mailing Address - Fax:979-830-4137
Practice Address - Street 1:2699 SCHULTE BLVD
Practice Address - Street 2:#703
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5994
Practice Address - Country:US
Practice Address - Phone:979-203-2294
Practice Address - Fax:979-830-4137
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant